Volume 10, Number 7 for health professionals who care for cancer patients July 2007

Website access at http://www.bccancer.bc.ca/HPI/ChemotherapyProtocols/stupdate.htm

I NSIDE THIS ISSUE

ƒ Editor’s Choice: New Treatment Policy: New
Funded Programs; Revised Treatment Policy:
Colorectal Cancer and Metastatic Renal Cell
Carcinoma; Withdrawal of 3-Weekly AC-T Regimen
for Early Breast Cancer, Rituximab for Primary
CNS Lymphoma
ƒ Cancer Drug Manual: Complete Revision:
Buserelin, Goserelin, Leuprolide; Chemotherapy
Stability Chart – Cyclophosphamide; Supportive
Care Handouts
ƒ New Drug Update: Oxaliplatin (ELOXATIN®) –
Health Canada Approval, Deletion of Calcium and
Magnesium Premedication; Temsirolimus for Renal
Cell Cancer via Health Canada’s Special Access
Programme
ƒ Communities Oncology Network: “Pharmacy Guide to
BCCA Chemotherapy Protocols” Now Available On-
Line
ƒ List of New and Revised Protocols, Pre-Printed Orders
and Patient Handouts: New: GOOVLDOX, GUBRADC,
UGUSUNI, UGUTEM, KSAD, KSLDO, KSVB, LYHDMRP
Revised: BRAJACT, BRAJTAM, BRAVTAM, CNB,
UGIAJFFOX, UGICAPOX, UGICOXB, UGIFFOXB,
GIFOLFIRI, UGIFOLFOX, GOCXRADC, GUBP, LUAVPEM,
LUAVTOP, LUMMPPEM
ƒ Nursing Article of the Month – Evidence-based
interventions for chemotherapy-induced nausea and
vomiting; Cytokine–release syndrome.
ƒ Continuing Education – BC Cancer Agency Annual
Cancer Conference 2007
ƒ Website Resources

IN TOUCH phone list is provided if additional information is needed.

EDITOR’S CHOICE
2007/08 NEW TREATMENT POLICY ANNOUNCEMENTS

The Provincial Systemic Therapy Program of the BC Cancer Agency is pleased to announce the funding of a
number of new treatment programs for fiscal year 2007/08. These programs will be implemented following the
development of the relevant treatment protocols, patient education materials and pre-printed orders.
Implementation of the new programs will be announced in the Systemic Therapy Update. The relevant
supporting documentation will be made available on the BC Cancer Agency web site (www.bccancer.bc.ca).
Funding decisions on other new treatment programs are in progress and will be announced in future issues of the
Systemic Therapy Update.

Curative/Adjuvant Protocols
Tumour Group Program Special Application Projected
Process implementation
date

Breast Adjuvant trastuzumab therapy with trastuzumab (class II) implemented (January
docetaxel followed by FEC (FinHer 2007)
regimen) for breast cancer (BRAJTDFEC)

Gastrointestinal Epirubicin-cisplatin with either capecitabine (class II) September 2007

fluorouracil (ECF) or capecitabine (ECC)
as perioperative chemotherapy for gastric
cancer

British Columbia Cancer Agency ♦ Provincial Systemic Therapy Program Update ♦ Vol. 10 No. 7 2007
1
Curative/Adjuvant Protocols
Tumour Group Program Special Application Projected
Process implementation
date

Breast Adjuvant trastuzumab therapy with trastuzumab (class II) implemented (January
docetaxel followed by FEC (FinHer 2007)
regimen) for breast cancer (BRAJTDFEC)

Gastrointestinal Epirubicin-cisplatin with either capecitabine (class II) September 2007

fluorouracil (ECF) or capecitabine (ECC)
as perioperative chemotherapy for gastric
cancer

Chronic Disease Protocols

Program Projected
Special Application
Tumour Group implementation
Process
date

Genitourinary Sunitinib for patients with metastatic renal case-by-case July 2007
cell carcinoma (clear cell type) after failure approval
of interferon or if unsuitable for interferon
(UGUSUNI) – also see Revised Treatment
Policy in Metastatic Renal Cell
Carcinoma in this issue

Genitourinary Sorafenib for patients with metastatic renal case-by-case July 2007
cell carcinoma (clear cell type) after failure approval
of interferon – also see Revised
Treatment Policy in Metastatic Renal
Cell Carcinoma in this issue

Sarcoma Sunitinib as second line treatment of case-by-case August 2007

metastatic gastrointestinal stromal tumour approval
after failure or intolerance of imatinib

Gynecological Pegylated liposomal doxorubicin class II July 2007

(CAELYX®) for relapsed/progressive
ovarian, fallopian tube or primary peritoneal
cancer (GOOVLDOX)

REVISED TREATMENT POLICY FOR COLORECTAL CANCER

Effective immediately, the Gastrointestinal Tumour Group has revised a number of treatment protocols and
provincial pre-printed orders (PPPOs):
1. The recommended first line therapy for metastatic colorectal cancer for patients suitable for combination
chemotherapy is FOLFIRI (GIFOLFIRI). This is a class II indication. Indications for considering first line
FOLFOX therapy as a substitute for FOLFIRI are:
a. Gilbert’s Syndrome
b. Peri-operative FOLFOX for patients with resectable/potentially resectable liver metastasis
c. Other concern regarding potential toxicity of irinotecan, to be specified by the treating oncologist.
This use of FOLFOX requires approval via the BCCA Compassionate Access Program (CAP)/Undesignated
Indication Request.

BRITISH COLUMBIA CANCER AGENCY ♦ PROVINCIAL SYSTEMIC THERAPY PROGRAM UPDATE ♦ VOL. 10 NO. 7 2007
2
2. FOLFOX is available as second line therapy for metastatic colorectal cancer. All oxaliplatin based therapy
(adjuvant [UGIAJFFOX]) OR metastatic [UGIFOLFOX]) remains subject to CAP/Undesignated Indication
approval.
3. For patients deemed suitable for bevacizumab based therapy, bevacizumab may be added to FIRST LINE
THERAPY ONLY for a maximum of 12 CYCLES in combination with FOLFIRI (UGIFFIRB). All
bevacizumab based therapy remains subject to CAP/Undesignated Indication approval. FOLFOX may be
considered in place of FOLFIRI for the above exceptions only (UGIFFOXB). Oncologists wishing to avoid
the use of bevacizumab with pre-operative therapy may apply for bevacizumab therapy in combination with
post-operative or second line therapy for those patients who proceed with resection of metastatic disease.
4. Due to early reports concerning a potentially reduced efficacy of oxaliplatin based therapy when used in
conjunction with intravenous calcium and magnesium administered for neurotoxicity prophylaxis, such
therapy will be removed from all oxaliplatin protocols and PPPOs until more mature data are forthcoming
(also see under Drug Update in this issue).
5. Capecitabine (GIAVCAP) remains an option for first line use in patients unsuitable for combination
chemotherapy. This remains a class II indication. Capecitabine as a substitute for infusional
fluorouracil/leucovorin in the combination oxaliplatin and irinotecan +/- bevacizumab regimens remains
subject to CAP/Undesignated Indication approval (UGICAPIRI, UGICIRB).

REVISED TREATMENT POLICY FOR METASTATIC RENAL CELL CARCINOMA (RCC)

The Genitourinary Tumour Group has introduced the funded treatment programs of Sunitinib (SUTENT®)
and sorafenib (NEXAVAR®) for patients with metastatic RCC. Patients must have a clear cell histology or
clear cell component. Histology should be obtained whenever possible. In the rare case where obtaining
histology is impossible, funding will be considered on a case-by-case basis.

Sunitinib is considered the reference standard for first line treatment of patients with advanced RCC, who are not
suitable candidates for interferon. Sorafenib can be considered for patients after cytokine failure. Sunitinib
represents an alternative to sorafenib in this indication. There will be NO funding for the sequential use of
sunitinib and sorafenib in patients progressing on one of the drugs. In selected cases, patients may be allowed to
switch between tyrosine kinase inhibitors if treatment has to be stopped for severe toxicity within the first 8
weeks of treatment. Sunitinib and sorafenib will only be available through the BCCA Compassionate Access
Program (CAP)/ Undesignated Indication Request. Every application will be reviewed for indication. There is
currently no approved therapy after sunitinib or sorafenib failure. Considering patients for clinical trials is
strongly recommended (please contact Dr. Christian Kollmannsberger or Dr. Kim Chi, Vancouver Centre – BC
Cancer Agency).

Interferon should only be considered in highly selected patients as per revised guidelines, such as young
patients with clear cell histology, good performance status, a progression-free interval following initial diagnosis
of more than 1 year and preferably lung metastases as the sole metastatic site.

Temsirolimus is available through Health Canada’s Special Access Program (SAP), in which the drug is
provided free of charge. It requires an application to Wyeth, the manufacturer, and Health Canada for each
patient. Temsirolimus within the SAP is the preferred treatment for all patients with poor prognosis criteria and
should be strongly considered for these patients. Applications for sunitinib for poor prognosis patients will only
be considered if patients do not qualify for temsirolimus through the SAP. Temsirolimus is also the preferred
treatment for patients with non-clear cell histology (Dutcher et al: ASCO 2007 abstract 5033).
References
1. Escudier B, Eisen T, Stadler W, et al. Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med 2007;356:125-34.
2. Motzer R, Rini B, Buzkowski R, et al. Sunitinib in patients with metastatic renal cell carcinoma. JAMA 2006;295:2516-24.
3. Motzer R, Michelson D, Redman B, et al. Activity of SU11248, a multitargeted inhibitor of vascular endothelial growth factor
receptor and platelet-derived growth factor receptor, in patients with metastatic renal cell carcinoma. J Clin Oncol 2006;24:16-24.
4. Motzer R, Hutson T, Tomczak P, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med
2007;356:115-24.

BRITISH COLUMBIA CANCER AGENCY ♦ PROVINCIAL SYSTEMIC THERAPY PROGRAM UPDATE ♦ VOL. 10 NO. 7 2007
3
5. Hudes G, Carducci M, Tomczak P, et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med
2007;356:2271-81.
6. Dutcher J, Szczylik C, Tannir N, et al. Correlation of survival with tumor histology, age, and prognostic risk group for previously
untreated patients with advanced renal cell carcinoma (adv RCC) receiving temsirolimus (TEMSR) or interferon-alpha (IFN). Proc
Am Soc Clin Oncol 2007:25(18S part I of II):243s (abstr 5033).

CHANGE IN AVAILABILITY OF BRAJACT FOR HER2 NEGATIVE EARLY BREAST CANCER

The Breast Systemic Therapy Group is withdrawing the BRAJACT protocol (3-weekly doxorubicin with
cyclophosphamide x 4 followed by paclitaxel x 4 [4AC-4T]) as a standard adjuvant breast cancer treatment
option in the HER2 negative population, based on mounting evidence (see below) that has reported superior
regimens and AC-T delivery schedule. Alternatives include the currently available BRAJACTG (2-weekly
dosing of AC-T with filgrastim [G-CSF] support). A weekly paclitaxel regimen could be considered if patients
cannot afford or tolerate filgrastim in the BRAJACTG regimen; 3-weekly dosing of AC for 4 cycles would be
followed by weekly paclitaxel for 12 cycles. Note that weekly paclitaxel requires approval via the BCCA
Compassionate Access Program (CAP)/Undesignated Indication Request; a protocol and pre-printed orders are
not at this time available but may be developed soon if there is sufficient need. As before, BRAJFEC and
BRAJCEF are also options, and for node positive patients, BRAJFECD or BRAJTAC, if deemed appropriate.

Comparative Data on 3-Weekly Dosing AC-T

The CALGB 9741 study compared standard 3-weekly 4AC-4T to a 2-weekly schedule with filgrastim support
(“dose dense”). There was a 7% absolute difference in recurrence at 4 years favouring the 2-weekly schedule
(BRAJACTG).1 In addition, data from the NCIC MA21 study showed that standard 3-weekly 4AC-4T was
inferior in terms of relapse free survival to CEF (absolute difference 5%) and dose dense/dose intense 6EC
(epirubicin/cyclophosphamide)-4T (absolute difference 4%) regimens.2,3 Finally, in the E1199 trial, presented at
the 2007 ASCO meeting, standard 3-weekly 4AC-4T was inferior to 4AC followed by 12 cycles of weekly
paclitaxel 80 mg/m2, with a hazard ratio of 1.32 for overall survival and 1.27 for disease free survival.4

For the HER2 positive breast cancer population who will be receiving trastuzumab, no change is proposed for
the regimen BRAJACTT. There has been no direct comparison of 3-weekly vs. weekly paclitaxel.
• NSABP B31 and Intergroup trials: paclitaxel and trastuzumab were given weekly.
• HERA trial: 4AC-4T was one of several chemotherapy options, and only 20% of the study population
received a taxane. Trastuzumab was given 3-weekly after completion of all chemotherapy.
• BCIRG study: docetaxel (not paclitaxel) was given after 4AC.
The decrease in relapse with the addition of trastuzumab may be sufficiently great that it washes out the benefit
associated with giving weekly rather than 3-weekly paclitaxel. For reasons of dosing convenience and lack of
data, the dose dense regimen (BRAJACTG) is not recommended when trastuzumab is given.

References
1. Citron ML, Berry DA, Cirrincione C, et al. Randomized trial of dose-dense versus conventionally scheduled and sequential versus
concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: first report of
Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. Journal of clinical oncology 2003;21(8):1431-9.
2. Burnell M, Levin M, Chapman JA, et al. A randomized trial of CEF versus dose dense EC followed by paclitaxel versus AC
followed by paclitaxel in women with node positive or high risk node negative breast cancer, NCIC CTG MA.21: results of an
interim analysis. (late breaking abstract 53). San Antonio Breast Cancer Symposium 2006. Available at:
http://www.abstracts2view.com/sabcs06/view.php?nu=SABCS06L_1217. Accessed 25 June 2007.
3. Burnell MJI, Levine MN, Chapman JA, et al. A phase III adjuvant trial of sequenced EC + filgrastim + epoetin-alpha followed by
paclitaxel compared to sequenced AC followed by paclitaxel compared to CEF in women with node-positive or high-risk node-
negative breast cancer (NCIC CTG MA.21). J Clin Oncol (Meeting Abstracts) 2007;25(18_suppl):550-.
4. Loesch DM, Greco F, O'Shaughnessy J, et al. A randomized, multicenter phase III trial comparing doxorubicin + cyclophosphamide
followed by paclitaxel or doxorubicin + paclitaxel followed by weekly paclitaxel as adjuvant therapy for high-risk breast cancer. J
Clin Oncol (Meeting Abstracts) 2007;25(18_suppl):517-.

BRITISH COLUMBIA CANCER AGENCY ♦ PROVINCIAL SYSTEMIC THERAPY PROGRAM UPDATE ♦ VOL. 10 NO. 7 2007
4
 RITUXIMAB FOR PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA (PCNSL)
The Lymphoma Tumour Group has introduced the use of rituximab with standard chemotherapy for
primary CNS lymphoma (PCNSL) of diffuse large B cell histology (LYHDMRP). The new regimen consists of
high-dose methotrexate with co-administration of rituximab 375 mg/m2 every 2 weeks for four doses.

Rituximab, an anti-CD20 monoclonal antibody, has been shown to improve survival in diffuse large B cell
lymphoma.1 As a large molecule, rituximab does not readily cross the intact blood brain barrier. However, low
concentrations of the drug can be found in the CSF of patients with disrupted brain vasculature due to tumour.2
Several phase II studies have shown that it is safe and feasible to combine rituximab with methotrexate for
primary treatment of PCNSL.3,4 This addition of rituximab brings the treatment of PCNSL in line with the
standard approach of adding rituximab to primary chemotherapy for diffuse large B-cell lymphoma, an approach
that has proven highly effective for systemic presentation of this lymphoma.5

References
1. Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell
lymphoma. N Engl J Med 2002;346(4):235-42.
2. Rubenstein JL, Combs D, Rosenberg J, et al. Rituximab therapy for CNS lymphomas: targeting the leptomeningeal compartment. Blood
2003;101(2):466-8.
3. El Kamar FG, Deangelis LM, Yahalom J, et al. Combined immunochemotherapy with reduced dose whole brain radiotherapy (WBRT) for newly
diagnosed patients with primary CNS lymphoma (PCNSL). J Clin Oncol (Meeting Abstracts) 2004;22(14_suppl):1518-.
4. Issa S, Hwang J, Karch J, et al. Treatment of primary CNS lymphoma with induction high-dose methotrexate, temozolomide, rituximab followed by
consolidation cytarabine/etoposide: A pilot study with biomarker analysis. J Clin Oncol (Meeting Abstracts) 2006;24(18_suppl):7595-.
5. Sehn LH, Donaldson J, Chhanabhai M, et al. Introduction of combined CHOP plus rituximab therapy dramatically improved outcome of diffuse large B-
cell lymphoma in British Columbia. J Clin Oncol 2005;23(22):5027-33.

CANCER DRUG MANUAL

Buserelin, Goserelin, Leuprolide Monographs and Handouts have been completely revised. Expert
review was provided by Drs. Susan Ellard (Breast Tumour Group) and Tom Pickles (Genitourinary Tumour
Group). Highlighted changes include:
ƒ addition of bone mineral density paragraph
ƒ addition of information on drug-induced disease flare in women
ƒ information about continued menstrual flow at the beginning of therapy
ƒ removal of buserelin nasal formulation (no longer available)

Chemotherapy Preparation and Stability Chart has been revised with new reconstitution information for
cyclophosphamide (CYTOXAN®, Bristol-Myers Squibb).

Supportive Care Handouts In many of our patient handouts, readers will notice references to handouts that
are not drug-specific, and not produced by the Cancer Drug Manual team; e.g., Help with Diarrhea during
Chemotherapy. If patients ask you for these handouts, do you know where to find them?
ƒ Staff at regional centres can access the following handouts at H:\EVERYONE\Patient Education\Nutrition:
ƒ Food Choices to Help Control Nausea
ƒ Help with Diarrhea During Chemotherapy
ƒ Suggestions for Dealing with Constipation
ƒ Food Ideas for a Sore Mouth during Chemotherapy
ƒ Food Ideas to Cope with Taste and Smell Changes
ƒ Food Ideas to Help with Decreased Appetite
ƒ Patient Guidelines for the Prevention of Osteoporosis in Women
ƒ Guidelines for the Prevention of Osteoporosis for Men with Prostate Cancer on Hormone Therapy
ƒ All regional cancer centre libraries can help individuals obtain copies of:
ƒ Your Bank to Energy Savings: How People with Cancer Can Handle Fatigue
ƒ Staff at CON sites should be aware that some handouts are available at www.bccancer.bc.ca/PPI/copingwithcancer.
As we work toward making all handouts available on-line, please contact BCCA Library if you need help
locating a supply of a particular handout.

BRITISH COLUMBIA CANCER AGENCY ♦ PROVINCIAL SYSTEMIC THERAPY PROGRAM UPDATE ♦ VOL. 10 NO. 7 2007
5
 DRUG UPDATE
Oxaliplatin There have been two major changes to the use of this agent for colorectal cancer:
1. Health Canada has recently approved oxaliplatin (ELOXATIN®) for the treatment of metastatic colorectal
cancer. Therefore, Health Canada’s Special Access Programme application is no longer required for the use
of the FOLFOX regimen. Oxaliplatin has been added to the BCCA Benefit Drug List and its use remains
subject to CAP/Undesignated Indication approval (more details under Revised Treatment Policy for
Colorectal Cancer in this issue).
2. Calcium/magnesium (Ca/Mg) infusions are currently NOT advised for neurotoxicity prophylaxis of
oxaliplatin until more mature data are available. All oxaliplatin based protocols and PPPOs have been
revised with the deletion of calcium/magnesium premedication.

Sanofi-aventis in the US has reported an unplanned interim analysis of data from a Phase IV study by the
Data Monitoring Committee. This indicated that Ca/Mg infusions, administered to reduce or prevent
oxaliplatin-associated neurological adverse events, may be associated with a reduced response rate to
FOLFOX/Bevacizumab treatment in the pooled population of patients receiving either the conventional or
the intermittent scheduled of oxaliplatin. Sanofi-aventis closed the study and intends to promptly collect and
analyse the study data and to present the findings when the analysis is complete.

Temsirolimus (TORISEL®) has recently been approved by the US Food and Drug Administration for advanced
renal cell carcinoma (RCC). In a phase III open-label study of previously untreated patients with advanced RCC,
temsirolimus compared to interferon was associated with a statistically significant increase in overall survival
(10.9 vs. 7.3 months, hazard ratio [HR] 0.73) and progression-free survival (5.5 vs. 3.1 months, HR 0.66). The
most common severe side effects were:
ƒ clinical symptoms: asthenia, dyspnea, rash, pain
ƒ laboratory changes: hypertriglyceridemia, anemia, hypophosphatemia, hyperglycemia, lymphopenia, and
neutropenia.

For more details, see the Revised Treatment Policy for Metastatic Renal Cell Carcinoma in this issue and Drugs
with Special Ordering Procedures on our website (www.bccancer.bc.ca/HPI/ChemotherapyProtocols/Forms).

COMMUNITIES ONCOLOGY NETWORK:

“PHARMACY GUIDE TO BCCA CHEMOTHERAPY PROTOCOLS” NOW AVAILABLE ON-LINE
Part I of the “Pharmacy Guide to BC Cancer Agency Chemotherapy Protocols: The Clinical Interpretation and
Application of Treatment Protocol Summaries” is now available in PDF format on the BCCA website at
http://www.bccancer.bc.ca/RS/CommunitiesOncologyNetwork/Educators/Pharmacists/guide.htm.

The hard copy of the Guide was developed, published and distributed by the BCCA Pharmacy CON Educators
in 2003. It has been well received by all who have used it, but is now out of print. The on-line version has been
revised and updated to reflect changes in practise since 2003 and will now be the only available version. Parts 2
(Example Case Studies) and 3 (Self-Assessment) will be available on-line later this year.

LIST OF NEW AND REVISED PROTOCOLS, PRE-PRINTED ORDERS AND PATIENT HANDOUTS
The BC Cancer Agency Protocol Summaries, Provincial Pre-Printed Orders (PPPOs) and
Patient Handouts are revised periodically. New and revised protocols, PPPOs and patient handouts for this
month are listed below. Protocol codes for treatments requiring “Compassionate Access Program” approval are
prefixed with the letter U.

BRITISH COLUMBIA CANCER AGENCY ♦ PROVINCIAL SYSTEMIC THERAPY PROGRAM UPDATE ♦ VOL. 10 NO. 7 2007
6
NEW PROTOCOLS, PPPOS AND PATIENT HANDOUTS (AFFECTED DOCUMENTS ARE CHECKED):
Patient
CODE Protocol PPPO Protocol Title
Handout
GOOVLDOX
; ; † Treatment of Relapsed/Progressing Epithelial Ovarian, Primary Peritoneal, or
Fallopian Tube Carcinoma, Using Pegylated Liposomal Doxorubicin

GUBRADC
; ; † Treatment of Locally Advanced Bladder Cancer Using Concurrent Cisplatin
with Radiation

UGUSUNI
; ; † Palliative Therapy for Renal Cell Carcinoma Using Sunitinib (SUTENT®)

UGUTEM
; ; † Therapy for Advanced Renal Cancer Using Temsirolimus

KSAD
† ; † Therapy for Kaposi's sarcoma with weekly Doxorubicin.

KSLDO
† ; † Kaposi's Sarcoma Using Liposomal Doxorubicin

KSVB
† ; † Therapy for Kaposi's Sarcoma Using Vinblastine-Vincristine

LYHDMRP
; † † Treatment of Primary Intracerebral Lymphoma with High Dose Methotrexate
and Rituximab

REVISED PROTOCOLS, PPPOS AND PATIENT HANDOUTS (AFFECTED DOCUMENTS ARE CHECKED):

CODE Protocol PPPO Patient Changes Protocol Title

Handout

BRAJACT ; ; ; deleted Adjuvant Therapy for Breast Cancer using

Doxorubicin

BRAJTAM † † ; side effect sections

revised
Adjuvant Therapy for Breast Cancer using
Tamoxifen.

BRAVTAM † † ; side effects sections

revised
Palliative Therapy for Breast Cancer Using
Tamoxifen.

CNB ; † † typo corrected in

Eligibility
Suppressive Therapy for Prolactinomas using
Bromocriptine

UGIAJFFOX
; ; † need for Special Access
Programme deleted,
calcium and magnesium
premedications deleted
Adjuvant Combination Chemotherapy for Stage III
Colon Cancer Using Oxaliplatin, 5-Fluorouracil
and Folinic Acid (Leucovorin).

UGICAPOX
; ; † need for Special Access
Programme deleted,
calcium and magnesium
premedications deleted
Palliative Combination Chemotherapy for
Metastatic Colorectal Cancer Using Oxaliplatin,
and Capecitabine.

BRITISH COLUMBIA CANCER AGENCY ♦ PROVINCIAL SYSTEMIC THERAPY PROGRAM UPDATE ♦ VOL. 10 NO. 7 2007
7
CODE Protocol PPPO Patient Changes Protocol Title
Handout

UGICOXB
; ; † need for Special Access
Programme deleted,
calcium and magnesium
premedications deleted
Palliative Combination Chemotherapy for
Metastatic Colorectal Cancer Using Oxaliplatin,
Bevacizumab and Capecitabine.

UGIFFOXB
; ; † need for Special Access
Programme deleted,
calcium and magnesium
premedications deleted
Palliative Combination Chemotherapy for
Metastatic Colorectal Cancer Using Oxaliplatin,
5-Fluorouracil, Folinic Acid (Leucovorin) and
Bevacizumab.

GIFOLFIRI ; † † eligibility revised

Palliative Combination Chemotherapy for
Metastatic Colorectal Cancer Using Irinotecan,
Fluorouracil and Folinic Acid (Leucovorin)

; ; † need for Special Access

Programme deleted,
Palliative Combination Chemotherapy for
UGIFOLFOX eligibility revised, Metastatic Colorectal Cancer Using Oxaliplatin,
calcium and magnesium 5-Fluorouracil and Folinic Acid (Leucovorin).
premedications deleted

GOCXRADC
; † † eligible histology
Treatment of High Risk Squamous Carcinoma,
Adenocarcinoma, or Adenosquamous Carcinoma
revised of the Cervix with Concurrent Cisplatin and
Radiation

GUBP ; ; † replaced by GUBRADC

Therapy for Locally-Advanced Bladder Cancer
Using Concurrent Cisplatin and Radiation

LUAVPEM
† ; † vitamin B12 injections
Second-Line Treatment Of Advanced Non-Small
added to appointments Cell Lung Cancer (NSCLC) With Pemetrexed
section

LUAVTOP ; ; † creatinine required Second Line Treatment Of Recurrent Small Cell

before each cycle Lung Cancer (SCLC) With Topotecan.

LUMMPPEM
† ; † vitamin B12 injections
Treatment of Malignant Mesothelioma with
added to appointments Platinum and Pemetrexed.
section

NURSING ARTICLE OF THE MONTH

Tipton, J. et al. (2007). Putting evidence into practice: Evidence-based interventions to prevent, manage and
treat chemotherapy-induced nausea and vomiting. Clinical Journal of Oncology Nursing 11(1), 69 - 78.

This article reviews and summarizes past and current empirical evidence related to both pharmacologic and non-
pharmacologic interventions for CINV. The general principles related to prevention and management of CINV
are summarized.

Breslin, S. (2007). Cytokine–release syndrome. Overview of nursing implications. Clinical Journal of

Oncology Nursing Supplement to 11(1), 37 – 42.

This article reviews the factors and processes related to infusion reactions that occur with administration of
monoclonal antibodies. The writer compares the physiological bases for allergic and cytokine release reactions,
describes how one can distinguish between them, and then outlines nursing implications and patient caregiver
education strategies.
BRITISH COLUMBIA CANCER AGENCY ♦ PROVINCIAL SYSTEMIC THERAPY PROGRAM UPDATE ♦ VOL. 10 NO. 7 2007
8
Follow this link to a quick review test to assess your knowledge about Cytokine Release Syndrome.
http://www.surveymonkey.com/s.aspx?sm=uJAajt5NAR5n4ywp3sTovw_3d_3d
(Both of these articles are included in the eHLbc databases and should be available online from most Health
Authority networks. If you can't get it by clicking this link, it is also available through the BCCA library or
through the health librarian in your region.)
http://search.ebscohost.com/login.aspx?direct=true&db=byh&AN=23943159&site=ehost-live
http://search.ebscohost.com/login.aspx?direct=true&db=byh&AN=23943123&site=ehost-live

CONTINUING EDUCATION
BC Cancer Agency Annual Cancer Conference 2007 Mark your calendar! This year’s conference will
be held on 29 November – 1 December, at the Westin Bayshore Resort & Marina in Vancouver. The theme of
the 2007 conference is “Technology and Innovation – Bench to Bedside”.
Stay tuned for more information about the conference.

WEBSITE RESOURCES
The following are available on the BC Cancer Agency website (www.bccancer.bc.ca) under the Health Professionals Info
section:
REIMBURSEMENT AND FORMS: BENEFIT DRUG LIST, www.bccancer.bc.ca/HPI/ChemotherapyProtocols/Forms
CLASS II, COMPASSIONATE ACCESS PROGRAM
(UNDESIGNATED INDICATION)
CANCER DRUG MANUAL www.bccancer.bc.ca/cdm
CANCER MANAGEMENT GUIDELINES www.bccancer.bc.ca/CaMgmtGuidelines
CANCER CHEMOTHERAPY PROTOCOLS www.bccancer.bc.ca/ChemoProtocols
CANCER CHEMOTHERAPY PRE-PRINTED ORDERS www.bccancer.bc.ca/ChemoProtocols under the index page of
each tumour site
SYSTEMIC THERAPY PROGRAM POLICIES www.bccancer.bc.ca/HPI/ChemotherapyProtocols/Policies
UNCONVENTIONAL CANCER THERAPIES MANUAL under Patient/Public Info, Unconventional Therapies

Editorial Review Board

Mário de Lemos, PharmD, MSc(Oncol) (Editor) Beth Morrison, MLS
Sarah Jennings, BSc(Biomed), BScPhm (Assistant Editor) Jaya Venkatesh, MHA, CMA
Caroline Lohrisch, MD Susan Walisser, BSc (Pharm)
Johanna Den Duyf, MA Gigi Concon (Editorial Assistant)
Judy Oliver, BScN, MEd
IN TOUCH www.bccancer.bc.ca bulletin@bccancer.bc.ca
BC CANCER AGENCY .............................................................. (604) 877-6000 ..................... Toll-Free 1-(800) 663-3333
COMMUNITIES ONCOLOGY NETWORK ...................................... Ext 2744................................ jvenkate@bccancer.bc.ca
EDUCATION RESOURCE NURSE .............................................. Ext 2638................................ nursinged@bccancer.bc.ca
NURSING PROFESSIONAL PRACTICE ........................................ Ext 2623................................ ilundie@bccancer.bc.ca
PHARMACY PROFESSIONAL PRACTICE ..................................... Ext 2247................................ gconcon@bccancer.bc.ca
PROVINCIAL SYSTEMIC THERAPY PROGRAM ............................ Ext 2247................................ gconcon@bccancer.bc.ca
COMMUNITIES ONCOLOGY NETWORK PHARMACIST .................. Ext 6277................................ lkovacic@bcancer.bc.ca
DRUG INFORMATION ............................................................... Ext 6275................................ druginfo@bccancer.bc.ca
LIBRARY/CANCER INFORMATION .............................................. 1-888-675-8001 .................... requests@bccancer.bc.ca
Ext 8003
OSCAR HELP DESK ............................................................... 1-888-355-0355 .................... oscar@bccancer.bc.ca
Fax (604) 708-2051
COMPASSIONATE ACCESS PROGRAM OFFICE ........................... Ext 6277................................ cap_bcca@bccancer.bc.ca
(FORMERLY UNDESIGNATED DRUG APPLICATION OFFICE) Fax (604) 708-2026
UPDATE EDITOR ..................................................................... Ext 2288................................ mdelemos@bccancer.bc.ca
CENTRE FOR THE SOUTHERN INTERIOR (CCSI) ....................... (250) 712-3900 ..................... Toll-Free 1-(888) 563-7773
FRASER VALLEY CENTRE (FVCC) ........................................... (604) 930-2098 ..................... Toll-Free 1-(800) 523-2885
VANCOUVER CENTRE (VCC) ................................................... (604) 877-6000 ..................... Toll-Free 1-(800) 663-3333
VANCOUVER ISLAND CENTRE (VICC) ...................................... (250) 519-5500 ..................... Toll-Free 1-(800) 670-3322

BRITISH COLUMBIA CANCER AGENCY ♦ PROVINCIAL SYSTEMIC THERAPY PROGRAM UPDATE ♦ VOL. 10 NO. 7 2007
9
BRITISH COLUMBIA CANCER AGENCY ♦ PROVINCIAL SYSTEMIC THERAPY PROGRAM UPDATE ♦ VOL. 10 NO. 7 2007
10